title: Pullout strength of misplaced pedicle screws in the thoracic and lumbar vertebrae - A cadaveric study.
abstract: BACKGROUND
  The objective of this cadaveric study was to analyze the effects of iatrogenic pedicle perforations from screw misplacement on the mean pullout strength of lower thoracic and lumbar pedicle screws. We also investigated the effect of bone mineral density (BMD), diameter of pedicle screws, and the region of spine on the pullout strength of pedicle screws.
  
  
  METHODS
  Sixty fresh human cadaveric vertebrae (D10-L2) were harvested. Dual-energy X-ray absorptiometry (DEXA) scan of vertebrae was done for BMD. Titanium pedicle screws of different diameters (5.2 and 6.2 mm) were inserted in the thoracic and lumbar segments after dividing the specimens into three groups: a) standard pedicle screw (no cortical perforation); b) screw with medial cortical perforation; and c) screw with lateral cortical perforation. Finally, pullout load of pedicle screws was recorded using INSTRON Universal Testing Machine.
  
  
  RESULTS
  Compared with standard placement, medially misplaced screws had 9.4% greater mean pullout strength and laterally misplaced screws had 47.3% lesser mean pullout strength. The pullout strength of the 6.2 mm pedicle screws was 33% greater than that of the 5.2 mm pedicle screws. The pullout load of pedicle screws in lumbar vertebra was 13.9% greater than that in the thoracic vertebra (P = 0.105), but it was not statistically significant. There was no significant difference between pullout loads of vertebra with different BMD (P = 0.901).
  
  
  CONCLUSIONS
  The mean pullout strength was less with lateral misplaced pedicle screws while medial misplaced pedicle screw had more pullout strength. The pullout load of 6.2 mm screws was greater than that of 5.2 mm pedicle screws. No significant correlation was found between bone mineral densities and the pullout strength of vertebra. Similarly, the pullout load of screw placed in thoracic and lumbar vertebrae was not significantly different.
authors.affiliation: Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Shyam K
authors.initials: SK
authors.lastname: Saraf
authors.forename: Ravindra P
authors.initials: RP
authors.lastname: Singh
authors.forename: Vakil
authors.initials: V
authors.lastname: Singh
authors.forename: Ashish
authors.initials: A
authors.lastname: Varma
keywords: Misplaced pedicle screw; pullout strength; vertebra